20011469 Ver 1_Complete File_20011005

Office Use Only:
USACE Action ID No.
Form Version April 2001
DWO No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
? 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s)Requested:NWP #3
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: T R Gibson, P E /NCDOT/Div 6/Division Engineer
Mailing Address: P.O. Box 1150
Fayetteville, NC 28302
Telephone Number: 910-486-1493 Fax Number: 910-486-1959
E-mail Address: t6bson(a?dot.state.nc.us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: same as above
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 1 of 9
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Bridge #1 Columbus County
2. T.I.P. Project Number (NCDOT Only): B-3439
3. Property Identification Number (Tax PIN):
4. Location
County: Columbus Nearest Town: Whiteville
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): 1.7 mile south of Bus. 74/76 on
Bus 701.
5. Site coordinates, if available (UTM or Lat/Long): 34.22°N 78.41°W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
Hiebway application - Existing Bridge
7. Property size (acres): Less than 1.0 Ac. _
8. Nearest body of water (stream/river/sound/ocean/lake): Soules Swamp
9. River Basin: Lumber River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http:/ih2o.enr.state.nc us/admin/maps/.)
10. Describe the purpose of the proposed work: Replace structurally deficient bridge with
Page 2 of 9
A new brid e.
11. List the type of equipment to be used to construct the project: Trackhoe Excavator
& Truck Crane
12. Describe the land use in the vicinity of this project: Urban
IV. Prior Project History
if jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
N/A
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: N/A
VI. Proposed Impacts to Waters of the United States/Waters of the State
it is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts
Wetland Impact Type of Impact' Area of Located within * Distance to
Site Number Impact 100- ear Flood lain* Nearest Stream Type of Wetland""
Page 3 of 9
indicate on ma acres es/no linear feet)
N/A

- - -t'----a ..,.... ..«,.i:.. 4711
* List each impact separately and identify temporary impacts. impacts include, our are not umncw w: u,cularli .cu C,,W-& &.......b.
excavation, flooding, ditching/drainage. etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://\ti,%N-i,\,.fema.go\,.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0 ac
Total area of wetland impact proposed: 0 ac
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)
Crossing #1 Bridge OLF Soules Swamp 45FL Perennial

ed
" List each impact separately and identify temporary impacts. Impacts mclude, but are not hmrted to: culverts and assoc?at r?p-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps arc available through the USGS at 1-800-358-9616, or online at
w w.usgs.uoy. Several internet sites also allow direct download and printing of USGS maps (e.g., A-Ay.tonozonc.com,
www.mamuest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: OLF
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact Type of Im act* Area of Name of Waterbod Type of Waterbod
Page 4 of 9
Site Number
indicate on ma Impact
acres (if applicable) (lake, pond, estuary, sound,
bay, ocean, etc.
N/A

* List each impact separately and identify temporary impacts. impacts include, but are not limited to: till, cxcavauou, tueugung,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Propose to replace an existing 3 scan timber and concrete bridge (52.2 OAL) with a 2 span
reinforced concrete and steel bridge (105.0 OAU Proposed bridge will increase flow
characteristics while reducing existing impacts to the waterway.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
Page 5 of 9
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http:/ih2o.enr.state.nc.us/ncwetlands/strmuide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offshe), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Mi i ati n not re uired.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
Page 6 of 9
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at httpl/12o cnr state nc us/%v[p/indcx.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Page 7 of 9
rt Impact multiplier Required
Zone (square feet) Mitigation
2
3
1.5
Total I I I-
• Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Erosion and sedimentation Plan shall be incorporated into the construction seauence.
X11. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
N/A
XM. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
Page 8 of 9
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
None
10#0
Applicant Agent's Signature /Dat'e
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office
US Army Corps Of Engineers
Post Office Box 1000
Washington, NC 27889-1000
Telephone: [phone]
Fax: [phone]
Beaufort Currituck Jones
Bertie Dare Lenoir
Camden Gates Martin
Carteret* Green Pamlico
Chowan Hertford Pasquotank
Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 9 of 10
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY.
GovERNOR
NCDENR Division of Water Quality
Robert Ridings
2321 Crabtree Blvd.
Suite 250
Raleigh, NC 27604-2260
LYNDO TIPPETT
SECRETARY
OCTOBER 1$, 2001
I
0?. 1 7
RE: NCDENR WQC 3290 / USACE NWP#3
DWQ# 011466 - Bridge #151 Replacement - Columbus County (B-3146)
DWQ# 011469 - Bridge #1 Replacement - Columbus County (B-3439)
DWQ# 011468 - Bridge #2 Replacement - Bladen County (B3411)
DWQ# 011467 - Bridge #197 Replacement - Robeson County (B-3367)
Dear Mr.Ridings:
Enclosed, please find two courtesy copies for bridge replacement projects within Division 6. The
projects will be completed in compliance with NCDENR Division of Water Quality General
Certification 3290 and USACE Nationwide Permit #3.
The PCN's for these projects were mailed by Division 6 Bridge Maintenance Department to
NCDENR for review under USACE NWP#31. Richard Spencer of the USACE has determined
that the projects will be permitted as NWP#3..Please disregard all previous notifications
pertaining to the above referenced projects.
If you should have any questions or comments regarding this notification, please feel free to
contact me.
cc: Richard Spencer, USACE
L.L. Upole, P.E.
Sincerely,
? ?wS
/James . Rerko, P'WS
Division 6 Environmental Officer
P. O. Box 1150, Fayetteville, NC 28302-1150 - Telephone [phone] - Fax [phone]
OtO? W A T ?9?G
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Gregory Thorpe
Division of Water Quality
October 10, 2001
DWQ# 011466 TIP # B-3146
DWQ# 011467 TIP # B-3367
DWQ# 011468 TIP # B-3411
DWQ# 011469 TIP# B-3439
L. L. Upole, Jr. P. E.
Division Bridge Maintenance Engineer
P. O. 1150
Fayetteville, NC 28302
Dear Mr. Upole:
On October 05, 2001, your applications for 401 Water Quality Certifications for projects in
Bladen, Columbus, and Robeson Counties were received by the N.C. Division of Water Quality.
Please note that beginning January 1, 1999, the N.C. General Assembly passed legislation requiring
payment of a fee for all 401 applications. Your applications are being put on hold since no payment
was received with the packages. The fee for applications is $200 for projects impacting less than an
acre of wetland and less than 150 linear feet of streams. For projects impacting one or more acres of
wetland or 150 or more feet of streams, the fee is $475. In order for DWQ to review and process your
request, you must send a check in the appropriate amount made payable to the N.C. Division of
Water Quality. Please refer it to DWQ Project #011466, DWQ Project # 011467, DWQ Project #
011468 and DWQ Project # 011469.
Please call me at 919-733-1786 or visit our web site at http://h2o.enr.state.nc.us/ncwetlands if
you have any questions regarding this fee.
Since ?y,
R
obert Ridings
cc: Central Files
File Copy
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
nIn 7O0 4709 MLn...+\ n40 711 R0n9 /f,-\ kt#-I/).7n - rlnln - ..r/n...unH.. r. rlnI
. -- Itt .

STA'TE OF NOItu i CAROLINA
DEPARTMENT Or TRANSPORTATION
MICI IAI L F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
l31idge Maintcnance Unit
P. O. Box 1150
Fayetteville, N. C. 28302
September 17, 2001
Division of["mhonmcntal Management
John Ilennc:>cy, WQ Certification Unit
P. O. Box 29535 '
Raleigh, N. C. 27626-0535
Dcar Mr. Ilcnncacy:
Please find tN%o (2) copies of the Pre-Construction Notification (PCN) application Conn for Water Quality Certification
Permits for your info. on thk project.
If you have any questions or comments, please call me at 910-829-6345.
Thank you fir your assistance in this matter.
Sincerely
L. L. IJpolc, lr, 1'. E.
Division 13ridge Maintenance Enginccr
Attachments
1'. O. Box 1150 - Fayetteville, N. C. 28302 - PIIONF: [phone] - FAX: [phone]
v
?lA1C n
S'I'iA"I 1: Or NOR"I'I I CAROLINA
DETARTNIENT OF TRANSPORTATION
Ml('llAFT 17. I;nSLEY LYNDO'I'IPPE17
( it )VI T N( W SECR1iTARY
13tidge Mainicnance Unit
11. O. 13 ox 115 O
aycllc\ille, N. C. 28102
Scptculhcr 1.1, 2001
1 ?S1A(?UE
Nip. Vidl:ud Sllcttccr
V"ilmiIII'lon Rcgnlatory Field Otlice
P ( I. Rox 1 SIM
Wilmi11gton, N. C. 25.102-1890
RFIT: ('(,1111111)11` County Bridge Number I Replacement ( III' 13-3.11())
I O('A i V)N: tIS 701 lhcr (irissct Swamp
Dcnr'\1r. Spencer
\1'c me liro\ idinn hcrc\\ills all applicaliml packal;C ,11111 copies of•N.C. Dep:ulment of'1-ranspottation
I1?draulic: (snit ,ketches (plan and profile) as a Iwt ofa project imokinp the replacement of an existing
h idhC %%ith ? IIC\P hI IIIf;L'. I IIC pto)CC1 should hC ICt to contract ill 2002.
To our k11o\\Icdi,c, no \\ctlanlls are ill%ol\cd and total lilt in watcr• is expected to he less than 0.01 acre. This bridge is
not located in a high yualily \catcr arra.
I'Ica';c rc\ ic\c this nlatclial, and it additional inGnm:Ilion is needed, plcasC contact our office.
.I h;u1k you for your coopemlion :Ind a, ?iklanee ill this matter.
Sincct?c'ly"wcQ?
1'. 1.. ( (pole, jr, PA:
Diei<io11 Bridge Maintenance P.n);i11cer
?1ltachnx•nty
CC: I. P. (iil,:on, PT. Dixicion f liginccr
John Hk-imcs,,cy UWO-7 Copies W/Allachmenls
Nlr,:. Rcnce GIC(lhill- Malley State I listotic I'Icscr\aliott ORicer
.til:c ClockCI-1)S Dish & Wildlife Scr\icc
lien Rriko-Di\'ision En\irunnxnlal Olliccr
V,O. Roxf 150-1a) (:Ile% llv. NC 283112 1'holle: (')1O-H29-63-15) ['ax: (910-329-6343)

f4 }}

Pre-Construction Notification (PCN) Application Form
For Section 40.1 and/or Section 10 Nationwide, Rctiion.11 anti General pel-nits, Section 401
(;eneral Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This 101-111 is to be used fur pro Jccts qualifying (Or any of tllc U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General i'crnlits as required by Section 404 of the Clean Water Act anti/or
Section 10 of' the Rivers and Ilarbors Act, and for the North Carolina Division of Water Quality's
(UWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This 1()1111 should not be used if you are requesting an Individual 404 Permit or Individual 401
Watcr Quality Certification. The USAGE Individual Pcrnlit application form is available online at
IItth_/tvNVN _sa«_tis{Ice.:lrmv.iIIil/\Vctlan(ls/I'cn»app_httn.
The USACE is the icad regulatory agency. To review the rcquircrnents for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
, or contact one of the field
USAC'E wcbsite at lIttp:/tvww_saw usacc.army.IIIil/yyctands!regtotlr.Il till
offices listed at the cnd of this application. The wcbsite also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U.S.
'i'he DWQ issues a corresponding Certification (General or individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants arc encouraged to visit DWQ's 401/Wetlands Unit wcbsite at
lit ip_,_/11?O.rlu;st itc.iic.us/iic\y'etl_;inrls to read about current requirements for the 401 Water Quality
Certification Prograin and to deternine whether or not Riparian Buffer Rulcs are applicable. The
applicant is also advisc(1 to read the full text of the General Certification (GC) matching the specific 404
T'crnlit requested. In some cases, written approval fOr some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Ul'licc in Ralcigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NC%%1RC) is also required fur 1lrojects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (liste(I by county on the last page of this application).
CAN1A Coordination, - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of' this apllication) the applicant should also contact the North Carolina Division of Coastal
Page I of' 12
Managcmcilt (1)('M) nt [phone]. DC'N1 will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCNI will act as the lead permitting agency.
In such cases, DCNI will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE1 1'el'nlils - Submit one copy of this filrrll, aloof; with supporting narratives, maps, data forms,
photos, etc. to the applicable USACL; Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt ofan application, the USACE: will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address infor-rllatlllrl needs fir all USACE; Nationwide, Regional or General pennits, as well as
information required tier State aulhorintions, certifications, and coordination. Fully providing the
information requested on this tbrnl will result in a complete application for any of the USACE
Nationwide, Regional or Gcncral permits. To review the nlininlurll amount of infonnation that must be
provided for a complete PCN for each USAC1 Nationwide permit, see Condition 13, 65 Fed.Reg. 12893
(March 9, 2000), available at i_lttt) -://??ww.sa???.(isarc.armiil/wetlands/nwpfinall'edlZc.?!.l elf:
Processing tinges vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office lilt specific answers to permit processing periods.
401 Water Quality Certification or BlIffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit nullerials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If' written approval is required or spccifically requested for a 401
Certification, then a non-rclundablc application fee is rcyuircd. Ill brief, if project impacts include less
than one acre of, cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a ice of 5200 is required. If either of these thresholds is exceeded, then a fee of $475 is
rcyuircd. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
inlilrnlation, see the DWQ website at http_/ili2o.chnr.Stabnc_us/ncwetlands/1ccs.html. The fee must be
attached with the application unless the applicant is a fcderal agency ill which case the check may be
issued from it separate office. Ill such cases, the project must be identifiable oil the U.S. Treasury check
so that it can he cre(fited to the appropriate project. lfwritten approval is sought solely for Buffer Rules,
the application fce sloes not apply, and the applicant should clearly state (in a cover letter) that only
Bu17cr Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver ofa Section 401 Water Quality Certification. Upon receipt ofa complete application
for a 401 Ccitilication, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of' additional
requested inlilrnlation, or denial.
Page 2of12
W ,
Office Use 0111N:
USACE, Action ID No.
Four Vcrsion April 2001
DNVQ No.
.? r1
Ifarty {articular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
Processing
Check all of*the approval(s) requested for this project:
Section 404 Permit
? Scclion 10 permit
X101 Watel' (Quality Certification
Riparian or Walcrshed 1311flcr Rules
2_ Nationwide, Regional or Gcneral Permit Number(s) Requested: 3L.-
3. ll'this notification is solely a courtesy copy because written approval for the,101 Certification
is not required, check here: ?
it. I l'payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of'impacts (sec section VIII - Mitigation), check liere: ?
11. Applicant Information
1. Owncr/Applicant Information
Name: T ?ibSo,S - NLoZ f(Jty. f /?'
r- --
?lailing Address:??.Q_/3o?c ]150
?]p
•fclephone Number: 910-r ?6_IY93 Fax Number:
jt[,soNr•SraL
I?-mail Address:-L I
2. Agent Information (A signal and dated copy of' the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: r? --A,6w-a
Company Affiliation:
Mailing Address: _
Telephone Number: -- Fax Number:
l::-mail Address: _
Paoe 3 of 12
M. Project information
j%ttach a vicinity map clearly showing the location of' the property with respect to local
1,1nlllllarks such as towns, rivers, and roads. Mso provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surlaccs, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS "topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. flan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. Fur administrative and distribution purposes, the
USACF, recquires inlornu?tion to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of' the bill-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
Nan?c of projecl:`Co IU1p?t S _La !t.f (??(AL?rLIi^?T Q F 11'L??
2. T.I.P. Project Number (NCDOT Only):_66 )
3. Property Identification Number ('fax PIN):
1. Location
Nearest Town:_r (J ><ITE Vi 1/E
Subdivision manic (include phase/lot number): ,'V-
Directions to site (include road numbers, landmarks, ctc.):
7 6
----- b17-
5. o a?
Site coordinates, ifavailable (UTM or Lat/Long): ?3J1Lz
(Note - 11'project is linear, such as a road or utility line, attach a slicct that separately lists the
coordinates tar each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the tinic of this application:
___Wj ;cl?, F
7. Property size (acres): LESS Tm r't ar.
8. Nearest body of water (stream/river/sound/ocean/lake):?(r is F??Sa?te!VO
9. River Basin: _LLw1&6_P _
(Note - this must be one of' North Carolina's seventeen designated major river basins. The
Rivcr Basin map is available at litti)://li2o ciir.st ite.fic.lis/a(imin/m,?l)s?/.)
10. Describe the purpose of the pro msed work:_RE plilee- S7?uebjj°1 ?! Fl e?F?T
J6 __ Paglof*12

v i
I ?'.
1 I . List the type ol'c(luipmcnt to be used to construct tile projCCL-J"?
12. i)cscl-lbe the land use in the vicinity ofthis projcct:_LJJz_ J&
Prior Project Ilistory
If jurisdictional deterriiiriations and/or permits have been requested and/or obtained for this
pro•jcct (including all prior phases of' the same subdivision) in the past, please explain. Include
the Action ID Nimilm-, DWQ Pro_jcct Number, application date, and date permits and
ccrtil ',160ns were issued or withdrawn. Provide photocopies of previously issued permits,
ccrtilications or other usclul hil'Ormation. Describe previously approved wetland, stream and
bUffCf- impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and dcscrll)c permits issuccl I'Or prior segments of the same T.I.P. project, along with
construction schedules.
V. Fut ure Project Phis
Ale any additional permit requests anticipated Iiir this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: NAL-
V1. Proposer,! Impacts to Wales of the Uaiteti States/Waters of the State
it is the applicant's (or agent's) responsibility to determine, delineate and neap all impacts to
wetlands, open water, and strcam channels associated with the project. The applicant must also
provide justification fir these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. /%if wetlands and waters, and all strcanis (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation tirrms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
rtiitigation, list and describe the impact in Section VIII below. If additional space is needed for
Iltillilg oi- dcscrlption, please attach a separate sheet.
1. Wetland Impacts
\Vctlancllntp,ul -------- ntcaol=-
Sitc Number I}pc of Intpact* Impact
(indic atr on :1 - - -- - _(acres)
,ocatC, within t)istance to
10O-}'car Pluodplain** Nearest strcvn Type of Wetland***
(ycs!no)?linca_fcct)
Page 5 of 12

- --------- -------
* I.i;t each impact Separate ,, and identify temporary impacts. Impacts include, but arc not limited to: mcchanizcd clearing, grading, fill,
cxcavhfion, flooding, (fiichin): (futinagc, ctc. For clams, scparately list impacts (file to both structure and flooding.
** 100-fear Iloodplain; are identified Ihrou):h the Federal Emergency hlanagenicnt Agency's (FENIA) Flood Insurance Rate Maps
I PIRA ), or FFAIA-approwd local floodplain maps. daps arc available through the FE-MA Map Scrvice Ccntcr at i-300-353-9616, or
onlineat hIIp:''%c .,v,fivrt!tov.
1-i;t a wclland type that beat dcscrihcs wetland to he impacted (e.g., Ikshwatuh,'almater marsh, forested wetland, beaver pond,
Cmolina It;ty, bog, cfe.)
List the total acreage (cstimatc(f) ofexisting wetlands on the property: 0
't'otal area of'wctlan(1 impact proposed: D
2. Strcant Impacts, including all intermittent and perennial strcams
- Strcant lnlpact
Site Number
(indicate on nt_th) - - -----
Type of Impact* - I_cnftth ol,
Impact
(linear feet) - --
Stream Name**
- Avcragc Width
of5trcam
Before Impact Perennial or
Intermittent?
(please specify)
-

* I i;t each impact separately and identity temporary impacts. Impacts include, but are not limited to: culwits and associated tip-rap,
(hills (separatcly lid impact; due to both structure and flooding), relocation (include lincar feet bcflote and allcr, and pct loss/gain),
stahilization activitic; (cement wall, rip-rah, ciih wall, ghhionz, etc.), excavation, ditching!strait;htenin;!, etc. If strewn relocation is
pn,poscd, plans and prutilcs Shuwin); the linear 10ofprint fOr both the original and relocated strcams must be included.
** Strcant nano; ran he tirruul un USGS topographic maps. It' a Strcant has no name, list as 11T (unnamed tributary) to the nearest
(fownchrhnt named strc:un into \%hich it flows. USGS maps arc available throut;lt the USGS at 1-800-353-9016, or online at
e,?,uSt;S.ruG'. Several internct site,,, also allow direct download and printing of USGS maps (e.g., www.to g,?one_a,nr,
w ?_`v inapduc l.?on), ctc.).
Cumulative impacts (lincar distance in feet) to all strcams on site: 0
Opcn Water Impacts, including Lakcs, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open
Sig
Water Impact
le Nuntbcr
1 pc of Impact* Arca of ,

Name of ?? at) y
impact (ifapplicabbllee) Type of Waterbody

(lake, pond, estuary, sound,
catc_on nt_r1i)- --- ---- - -_- (acres bay, ocean etc.)
page 6 of 12
I a
' List cacti impact separately and
flooding, dlaina ,e, hulkhcad:, etc.
idcntily lempormy impacts. Impacts include, but arc not limited to: fill, excavation. dredging,
-l. road Creation
It' construction of' a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method ol, construction (e.g., dam/embankment, excavation, installation of'
draw-down valve or spillway, ctc.):Al bj?
i'ropused use or pul-posk, of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local storilnwatcr rcquircnnent, ctc.):
Size of watershed draining to pond: Expected pond surface area
VII. Impact .1 listification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
i ll'Onnation related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be ibllowed during construction to reduce impacts.
_?t4.o a r_E--Z_t2?E ?X iSr?s??-_S?-8>`n?tft°ET? ?!J1?r? Clrt4 1?? ,
V111. Mitigation
DWQ - In accordance with 15A NCAC 211 .0500, mitigation may be required by the NC
Division of'Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or ctfual to 150 linear feet of total impacts to perennial
stl'callls.
USACE - In accordance with the final Notice of Issuance Auld Niodification of Nationwide
1'cl'lllits, published in the Federal Register on March 9, 2000, mitigation will be required wllcil
Pare 7 of 12
I
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including sire and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in detcrrnlning acceptability of appropriate and practicable
mitigation as proposed. Fxamplcs of?mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, prcicrable in the same watershed.
I I'mitigation is required for this project, a copy of the mitigation plan must be attached in order
fir USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
Iittp_r_h?_o.cnr.st_ite.iic.us/ncwctIall(is/strnIi.;icle.ht1111.
Provide a bricl' description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limitccl to: site location (attach directions
and/or map, if oflsitc), affcctcd stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., decd restrictions, conservation cascmcnt, ctc.), and a
description ofthe current site conditions and proposed method ofconstruction. Please attach
a separate sheet i f more space is needed.
N /A
2. Nlitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) wit?r the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved helore it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the •101/Wctlands Unit if payment into the
NCWRP is available as an option. For additional information regarding, the application
process for the NCWRP, check the NCWRP website at ht ?;//Ih2c?_rnr.sintc.tic. u?/%%? ndex.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the lollowing infin-mation:
Amount of strrtrir iuiligation rcqucstcd (linear feet): 0
Page 8 of' 12
I .• 0
Amount of hufter mitigation requested (square feet): a
Amount of Riparian wetland mitigation requested (acres): 0
Amount of Non-riparian wetland mitigation requested (acres)
Amount of Coastal wetland mitigation requester} (acres):
IX. E.nvironntcntal Documentation (I)WQ Only)
Does the project involve an cxpcnditurc of public funds or the use of public (federal/state/local)
land''
Yes No ?
if yes, does file project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you arc not sure whcthcr a NEI'A/SEPA document is rcyuircd, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
Ifycs, has the documcnt review been finalized by the State Clearinghouse? If'so, please attach a
copy ofthc NEPA or SEPA final approval letter.
Yes ? No [
X. Proposed impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
rcyuircd state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section V11 above. All proposed impacts must be listed licrcin,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buf'lcrs. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Ncusc), 15A NCAC 213 .0251) (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply Buffer Re(luirements), or other (please identify-- )?
Yes ? No (I I f you answcrcd "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. if buffer
mitigation is required calculate file required amount of mitigation by applying the buffer
multipliers.
----
Zone* -
--Intp,art --
- -- NI-L1--1 ir-ilicr ----
Recruited
I 3
1.5
--- -`-Total -
' /.one l extends out 311 fcet hcrf,cnelicul,tr bunt near bank of manna; [.one Z cxtcnus an
I
:ul(litional 20 feet lion the edge nl'Lonc I.
Page 1) of 1
i

lf,butfcr mitigation is required, please discuss what type ofmitigation is proposed (i.e., Donation
of Property, Conservation Eascnrcnt, Riparian Buffcr Restoration / Enhancement, Preservation or
Payment into the Riparian E3ufler Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 213 .02,12 or .0260.
11. Stor1111vater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
w/A
X11. SCNV:?t;e Disposal (DWQ Only)
Clearly detail the ultimate tre:?tmcnt methods and disposition (non-discharge or discharge) of
wastewater gmicrated from the proposed project, or available capacity of the subject facility.
iv /,I
1111. Violations (DwQ Only)
Is this site in violation of DWQ Wctland Rules (15A NCAC 211 .0500) or any Buffer Rules?
Ycs ? No IN
Is this an alter-the-fact permit application?
Yes ? No IV]
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these pennits. I-lowever, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules fir lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside ofthe applicant's control).
- - N n n) i=
- - --- - - -- -
t'acc. -----
10 of 12
/L
AppllcantlAgclll' s Signature Date
(Agent's signature is valid only it- an autllOr*z ltiorl letter liom th e applicant is provided.)
US Army Cork' s Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee hedell Mitchell Union
I 1S Army Cor3)s of linginecrs Averv Clay Jackson folk Watauga
151 Patton Avenue 131111cornhe Cleveland Lincoln Rowan Yancey
Roost 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabal rus Graham Madison Stanley
'telephone: [phone] Caldwell Ilaywood McDowell Swain
Fax: [phone] Catawba Ilenderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Ahmance Duthant Johnston Rockingham Wilson
US Army Cot I),; (?f Engineers Allegheny Edgecombe I_ce Stokes Yadkin
6503 Falls of the Ncuse Road Ashe Franklin Nash Surry
Suitc 120 C'as%wll Forsyth Northampton V:vtce
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone],141 Davidson Guilford Person Warren
Fax: [phone] Davic IIa]if x Randolph Wilkes
Washington Regulatory Field Office Bealdinl Currituck Jones Pitt
US Arnly Corps Of Euginccrs Berrie Dare Lenoir Tyrrell
Post Officc Box 1000 Camden Gatcs Martin Washington
Washington, NC 27889-1000 Cartcrct* Green Pamlico Wayne
Telephone: [phone] Chowan Ilcrtfirrd Pasyuotank
Fax: [phone] Craven I lyde Pcryuituans *Croatan Nati onal Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Arnly Corps Of Fit"incels Blades I Iaructt I'cndcr
Post Office Box 1890 limnswick Bloke Richmond
Wilmington, NC 28.102-1890 Carteret Nlontgoutcry Robeson
rclephone: [phone] Columbus Moore Sampson
Fax: (910) 2 5 1 A 0 2 5 Cumberland New hanocer Scotland
US Fish and Wildlife Service / National Marine Fisheries Service
US Dish and \Vildlile Service US Dish and Wildlife Service National Marine Fisheries Servicc
Raleigh Field Office Asheville Field Office I Iabitat Conservation Division
Post Office Box 33726 160 7,illicoa Strcet Pivcrs Island
Raleigh, NC 276.16-3726 Asheville, NC 28801 13caufort, NC 23516
Tclephrnte: [phone] 'telephone: [phone] Telcphol?c: [phone]
North Carolina State Agencies
Division of Watct Quality
•101 Wetlands Unit
1650 Mail Setvice Center
Raleigh, NC 27699-1650
Tclcphonc: [phone]
Fax: [phone]
Division of Water Quality
WNlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
Page I 1 of 12

CANIA anti NC Coastal Counties
Division ol,Coastal Management Beaufort Chowan Ilertford Pasquotank
1633 Mail Service Ccntcr Bettie Cravcn Hyde Pender
Raleigh. NC 27699-163,S Brunswick Currituck New Ilanovcr Perquirnans
'telephone: [phone] Camden Dare Onslow Tyrrcll
Fax: [phone] Carteret Gates Pamlico Washington
NCNN'RC and NC Trout Counties
Wc.tcrn Piedmont Region Coordinator
3155 Idlewild (toad
hcrllcrsville, NC 2725.1-91 80
Tclcphone: [phone]
Mountain Region Coordinator
20`30 Gtcat Smoky Mtn. Expressway
Waynesville. NC 28 786
Telephone: [phone],16
I--as: [phone]
Alleghany Caldwell
Ashe Mitchell
Avery Stokes
Burke Surry
Buncombe Ilendcrson
Cllcrokce Jackson
Clay Macon
Grahanl Madison
Ilaywood McDowell
Watauga
Wilkes
Polk
Rutherford
Swain
Transylvania
Yancey
Page 12 of' 12
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